Parkinson's disease mortality in the United States, 1999-2025: a national multiple-cause-of-death analysis with projections to 2030.

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder in the United States and a growing driver of late-life disability and death. We characterized U.S. PD-related mortality from 1999 to 2025 and projected it to 2030. Methods: In this serial cross-sectional analysis of CDC WONDER Multiple Cause of Death data, PD-related deaths in adults aged ≥45 years were identified using ICD-10 code G20 recorded anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 100,000 were decomposed by joinpoint regression and projected to 2030 using a log-scale ensemble weighted by rolling-origin back-test error, stratified by sex, age, race and ethnicity, census region, and degree of urbanization. Results: Among 1,149,731 PD-related deaths (59.8% men), the overall AAMR was 32.74 in 1999 and 41.03 (95% CI 40.70-41.35) in 2025, but the full-window trend was not significant (average annual percent change 0.56%; -0.10 to 1.22; Conclusion: Age-adjusted PD-related mortality did not change significantly between 1999 and 2025. Most of the post-2021 decline reflects the unwinding of COVID-19 co-listing rather than an improvement in underlying mortality, a mechanism that is now nearly exhausted. Projections indicate a plateau in the standardized rate, while absolute deaths rise with population aging, and end-of-life care has shifted from institutions to homes.